North Dekalb Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTH DEKALB PRIMARY CARE, LLC

Practice address

136 Commerce Ave
Valley Head, AL 35989

Phone

(256) 674-1052

Fax

(256) 674-1054

NPI assigned

Apr 10, 2018

Last updated

Apr 17, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Moore, CRNPNPI 1518200864

Title

Owner

Phone

(256) 996-0540

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Wayne Moore, CRNP

  • Nurse Practitioner
  • Valley Head, AL
  • NPI 1518200864
  Medicare reassignment NPD Authorized official
• Charles Raymond Bradford IV, M.D.

  • Family Medicine Physician
  • Scottsboro, AL
  • NPI 1427085133
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1851898449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38109 US HIGHWAY 11",
            "city": "VALLEY HEAD",
            "state": "AL",
            "postal_code": "359894432",
            "telephone_number": "256-996-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 COMMERCE AVE",
            "city": "VALLEY HEAD",
            "state": "AL",
            "postal_code": "35989",
            "telephone_number": "256-674-1052",
            "fax_number": "256-674-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DEKALB PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-10",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-996-0540",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anesthesia Management Group of North Alabama,LLC
• Chiara Focardi, NBCCH
• Lori B Gustafson, PTA
• Alisha Hamidian, PMHNP-BC
• John Wayne Moore, CRNP
• Valley Head Drugs LLC

• Family Medicine Physician in Valley Head, AL
• Providers in Valley Head, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.